Not saying 'no'

I'm sitting in Prague airport after yesterday's 1-dayer for a new client.  It will the last of 47 flights in 2011.

The job, a sort of six hour pitch to a pan-European mix of marketing and medical people, went well enough.  It was one of those situations where whilst the people who need to approve the project weren't in the room, there were plenty there who could kill it.  That gave me a very clear and not especially ambitious goal: to not have anyone say 'no'.

I had my usual mid-morning moment when it occurred to me that this may the last job I ever do; at the very least with this client and possibly ever.  This is my subconscience telling to relax, stop worrying about the next job and to simply concentrate on the people in front me.

By the time we decamped to the bar for too much Czech beer there was sufficient agreement that the project should go forward.  The clarity of a business model where you only attempt to be as good as your last job can be very liberating at times.

Natural, complicated, simple

The cricket writer Peter Roebuck committed suicide a few weeks ago in South Africa.  His death is rightly mourned by the legion fans of his astute and erudite writing.  As he taught English at my school and lived in the boarding house, despite being an especially mediocre cricketer I had quite a bit to do with him.

Of all the tributes that have been written my favourite is by Ed Smith, the former Kent and England player who writes for the times.  In it he recounts some advice Roebuck had written to him years before: -

A player goes through three stages - natural, complicated, simple - not many reach that last stage but the journey cannot be avoided

As ever cricket acts as a mirror to all of life.  As a consultant my job is to usher people and organisations to that final state and I've learned not to trust anyone who declares with relish that some process or situation is necessarily complicated.

I especially like the idea of an unavoidable journey to simplicity.

Identity Economics

I've just finished reading Akerlof & Kranton's Identity Economics, a pretty lightweight exploration of the obvious idea that there is a quasi-quantifiable cost to pursuing financial gain at the expense of one's personal identity.  Much of the book is driven by the idea that 'insider' behaviours, the conformist ones that further the goals of the organisation (but also lead to personal advancement), must outweigh the social cost of being seen to conform by one's sneering peers.  There's nothing much here that wasn't explored more eloquently in John Hughes' 1985 opus The Breakfast Club.

When discussing the effect that identity economics has on education the authors focus on ways in which well-run schools (such as the Core Knowledge group run out of Colorado) create a compelling 'insider' culture: -

Because identity is closely linked to dress and self-presentation, we consider it no coincidence that a Core Knowledge school might prescribe even the nature of a student's socks. 

Identity Economics. p. 73

The premise is that how we dress acts as a constant reinforcement of who we are: conformist 'insider' versus rebellious 'outsider'; and that this internalised effect is arguably more important than how others perceive us.

I'm interested in how this idea relates to how a consultant dresses when meeting a client, especially for the first time.  If Akerlof & Kranton's idea holds true then ahead of any other considerations we need to dress for ourselves.  If I don't feel that what I'm wearing reinforces a positive self-image then that dissonance will somehow out itself during the meeting.

When starting out in life this is in no way trivial.  You didn't make it at IBM in its pomp if you didn't aspire to dress like these guys.  Reductio ad absurdum: -

Before choosing a career you need to ask yourself if you like how the successful people in that field dress

When you're paying your dues in any profession you will need to wear clothes that don't distract from the perception of your work.  You will have to wait until you're game-changingly good at what you do before you can dress in a way that draws attention to who you are as opposed to what you do.  Of course this only applies if you're serious about your career (i.e. want to be one of Akerlof & Kranton's 'insiders').  Dress in a way that says 'fuck off to the man' and sooner or later the man will get fucked off.  With you.

I like how I dress for meetings.  By this I mean I genuinely enjoy wearing those clothes because they make me feel how I need to feel when meeting a new client: established, intelligent, perceptive and 'undistracted'.  It's taken me a while to understand this and I do my best to address the myriad shifts in how I feel about a certain suit or shirt when I walk out the door in the morning.

That I never achieved the same comfort in the clothes I wore as a stand-up speaks volumes: dressing like my audience made me feel like an impostor whereas dressing like me just made me feel old.  And Andrew Watts had already cornered the market in disheveled suits.

Funny. And good in bed

My wife and I are back in Australia. We're staying with her mother and family in Sydney for a week or so. Almost everyone in the household is either self-employed or working for a start-up, which offers up some really interesting compare-and-contrast breakfast table conversations.

Hal has had several successful careers but now works from home as a foreign exchange trader. The arrangement is that he trades for himself but as part of a global cohort whose aggregate efforts are on behalf of an investment fund.  The business follows a sort of league table approach whereby as he proves his abilities the organisation allows him to trade larger amounts and so earn more.

After a year or so he's developed a keen sense of the market and is highly aware of the the combination of volume and volatility (driven by planned and unplanned news events) he needs to thrive and has climbed several rungs on the ladder already.  To do so he's adopted all the necessary professional behaviours that I would say are actually more important when working from home than anywhere else.  He'd no more trade with a hangover than I'd walk into a training room naked.

As I looked at the procession of charts and numbers flickering across the three screens on his desk I thought, "I could do that."

Of course I did. Men of my age and education all reckon we're the funniest guy at the party, a porn star in the bedroom, a Navy SEAL in a bar fight and a 'big swinging dick' in front of the trading screens

The peak of everything

Jean-Claude Carriere is possibly the most famous scriptwriter you've never heard of.  Since the 1960's he's lived a sort of Zelig-like existence, collaborating with some of the best and more interesting film and theatre directors of the last fifty years; Milos Forman, Luis Bunuel, Philip Kaufmann, Peter Brook and Jean-Luc Goddard.

I recently came across in old NYT love-piece from 1988 that describes Carriere driving across the Seine with the photographer Robert Doisneau (y'know, this guy): -

Carrière gazes through the windshield at the soft outlines of the fog-shrouded buildings. “J’aime bien ça,” he says contentedly. 

“That’s because you’re starting to get old,” Doisneau replies. “When you’re young you see only the details. When you grow up, you see both the details and the whole. That’s the peak of everything, it’s what you’ve lived for. When you get old, you forget about the details and see only the whole.”

Nice to think I feel that I might be at an age when I can see the details and the whole at once.

The last frontier

For my business the United States is the last frontier.  After almost seven years working out of London I'm relatively pleased as to how my presence has grown in Europe.  I am a known quantity here now and my clients seek me out as much as I seek out them.  In December I'm starting a new project with an old client.  Our third in ten years.  Every time he changes jobs I get a call.

I wonder if the experience would have been as successful if my wife and I had chosen instead to live in the US when we left Australia in 2005.  The challenge of getting visas notwithstanding the choice was ours to make as no company forced our hand by funding the relocation.  I suppose we just liked the idea of Europe more.

I've never felt as confident walking into an American Head Office as an Australian, British, Swiss or Asian one. Nowhere else in the world are foreign accents such a source of undisguised bemusement.  I don't respond especially well to the blank-eyed apathy that seems to say: -

Buddy, we're the richest pharmaceutical market in the world.  There are over 300 million of us here.  If your idea was that good don't you think we'd have thought of it by now already?

The only genuine traction I've had on American projects has been with European owned companies.  My theory is that there's a sense that ideas should be assessed on value not provenance.  Yet America beckons and yesterday I spent an hour on the phone with a Boston consultancy whose task would be to get me into the meeting where my ideas are heard louder than my accent.

One of the problems we discussed was that most Americans in bourgeois industries like pharma are just too damn polite.  Offering a London-based consultant a project in the Midwest might be asking a bit too much of him, what with all that inconvenient travel and time away from his family and whatnot.

Convincing a client that I'll travel anywhere on the planet for the right fee can be a surprisingly high hurdle when landing an overseas gig. This is why consultants never complain about jetlag.  Convincing my potential American clients that transatlantic travel is still just travel may be a step too far and I suspect the consultancy will recommend I relocate the business to somewhere in the corridor between Boston and Philadelphia.  Hopefully he'll also suggest less extreme alternatives but I've yet to see any evidence that you can succeed in America with anything less than a display of total commitment.

So cool

 I've only just found xkcd.

So, so cool...

Pesky verbs

Further to yesterday's thoughts on the descriptive noun (art v. science) this week I've been dealing with an even slipperier conundrum, the verb. To whit: -

What is an appropriate euphemism for 'selling'?

For some quite understandable reasons the client has decided that the guys on the road wot talk to doctors are hereon out to be referred to as 'health solutions managers'. Because nobody likes being 'sold to' right? But there sure as hell are plenty of health solutions out there that need managing: -

Beware of Greeks bearing gifts and solutions in search of problems.

I accept that in much of the world 'salesman' is a tainted word; derisively associated with sharp practices (double glazing in the UK, used cars elsewhere) but excising it from the corporate vocab leaves an glaring absence. Accountants account, researchers research and receptionists receive. Managers either run a team of people or have responsibility for a project or process or else they do... what?

We spent much of the week exploring what it might mean to manage a health solution when the behaviours we want to see exhibited in front of the customer looked consistently salesy.

If it walks like a duck and quacks like a duck then why are we struggling so hard to name the damn thing?

As I said, the client has understandable reasons for wanting this rebrand but as the behaviours (the verbs) aren't changing then was it any wonder that we spent the week wading through euphemisms?

The art of selling

The Schumpeter column in the October 22 Economist (no link available) explores the issue of variability amongst sales teams: -

the performance of salespeople within a single company typically varies by a factor of three.  And the difference between the best and worst companies when it comes to selling is far greater than the difference for functions such as supply-chain management, purchasing or finance.

I guess I'm so close to this issue (I spend so much time with sales teams, albeit only in health care) that the cross-departmental comparison surprised me.  An acceptance of such a broad spread in performance within a team undoubtedly leads to this greater variability between teams or companies.  Most of my clients implicitly employ me to improve the performance of the middle 70%; the thinking being that the top 15% are alchemists who we do well to leave undisturbed and the bottom 15% are heading out the door anyway.

The article speaks to the problem that it is so difficult to first standardise, then reproduce, the behaviours of the high performers that companies are left frustrated, reduced to describing selling as an 'art' as opposed to a 'science'.  I have no problem with this frustration (in fact it benefits me) because I don't see science and art as polar opposites.  Furthermore the better metrics that science requires are often fool's gold: -

Firms are starting to track reps much more closely, usually to their dismay.  Salesforce.com sells tools which allow sales managers to track on a daily basis what their minions are up to.

A number of clients of mine have been taken in by salesforce.com and similar tracking systems and after nine or so months the same 70-30 rule applies: 15% are unreplicably good, 15% aren't suited to the gig and then there's everyone else.  The problem with tracking that middle 70% and the rewarding them on measurable behaviours is that, as the old sales axiom has it, you should expect what you inspect and alas, the measurable behaviours of the alchemists aren't the ones responsible for their success.  Furthermore, systems like salesforce.com only work at all when the reps themselves enter the information about what they're doing into the system.

I like salespeople.  It's isn't hard to like people whose job it is to be likeable.  The immeasurable that I recognise in the good ones is the same as with high-performing actors, improvisers and stand-up comics, all of whom say words aloud for a living: when they are on the job they are present.   This translates into a wonderful ability to slow time such that the thing they say is the only thing that needs saying.

Part of my job is to encourage my clients to see their employees as artists of sorts (we're called Dramatic Change after all).  Too much salesforce.com has the effect of turning them into data entry clerks of their own behaviour, which isn't science so much as drudgery.

Inclination v. Obligation

Work is an obligation. Even if I really like my job (so much of the time of inclined to do it) I'm obliged to do it regardless of any momentary preference.

When our weekends and holidays 'feel like work' it's because we find ourselves obliged to do things during time we'd mentally put aside to pursue our inclinations. We like our friends because they're similarly inclined to us; time spent with them doesn't feel like an obligation.

I'm visiting Australia again in a few weeks and there's nothing like a trip home to focus the mind: which activities and engagements am I obliged to do, which am I inclined to do and which ones sit happily in the centre zone of a simple Venn Diagram?

This trip will be far more complicated because my wife and I are traveling together. As our separate and collective diaries fill up we're negotiating a much more complex Venn Diagram: there are things that are inclinations for one but obligations for the other, things that are obligations for us both and happily a few things that we're each inclined to do.

Travel alone and the trade-offs are purely internal. Travel with someone else and the negotiations need to be overt and honest otherwise we end up dragging the other person to events that we're only attending out of obligation anyway.

Adult life is a lesson in compromise and never more so than when returning to the sites of your childhood.

Dreading the week ahead

My 'To Do List' program, Things for Mac, crashed on Saturday morning. At first it was a simple failure to synch between desktop and iPhone but the usual solutions as suggested by the user forums not only failed to fix the fault but made things much, much worse. In trying to copy my database to back it up I managed to delete it altogether.

I've been ambushed by my beloved technology and I approach the week with a woefully imprecise idea of what needs doing.

A week I won't get back

I live in London and mostly work in Europe.  I have a few North American clients and would like more and I have one in Asia.  The rest of the Asia-Pac business is handled by an erstwhile business partner who lives in New Zealand.  I'd like to think I'm pretty good at long-distance collaboration.

This week I've been dealing with two quite different men who want to do me the favour of taking my work to new clients.  One is setting up a consultancy in the Middle East and reckons that he can generate a demand for our IP in the region and the other needs my skills to round out a product offering that he's making (speculatively) to a Canadian company.  Both men are entrepreneurs who have identified potentially lucrative opportunities that would never come across my radar.  But each has inserted himself between me and a client and I'm unsure how I feel about that because like most Headcount: 1 types I'm a control freak.  If anyone's going to be in front of a client or an audience it will be me.

This control freakery has been going on so long that I've learnt to treat it as a strength rather than the flaw it is.  Being unable to delegate means that my business will never, ever be scaleable, ergo it will never be saleable.  And as I've said before on these pages, when I get down about this I feel trapped.  If I can't relinquish control of the marketing interactions with clients in far-flung places that I'd never meet otherwise then when can I?

Isn't this just 20th Century Thinking?  Wasn't one of the key learnings from the life of Saint Steve Jobs that an overweening sense of control is a positive thing?  Merlin Mann recently described success, apropos of Apple, as: -

You get to decide who pays you

I suspect that my erstwhile partner doesn't care who pays us for our residual IP.  He sees this incremental (and essentially unearned) income purely as a bonus, as an undiluted good, and especially in markets like Egypt and Saudi and the Gulf.  I'm not sure I agree.   I want my collaborations to enhance not diminish what I do.  I want to finish a project with a stronger brand, a more interesting product and a new set of experiences.

And before we've even gotten to a proper pitch meeting each relationship has gotten bogged down in a separate legal morass.  I've spent the last week proofing licensing agreements and drafting cautionary emails.  The last seven days' efforts have been about protecting what's mine now instead of creating a better, cooler something for tomorrow.

My business is such that I can't license my way to wealth and I certainly can't sue my way there.  A week spent neither developing new ideas or delivering existing ones is a week wasted

Chien noir. Perro negro. Cane nero...

At a dinner at a European pharma meeting last night the conversation couldn't escape the financial crisis. Budgets slashed. Health ministries paralysed by the turmoil. Every hospital, therapy area, patient group and drug company desperately seeking an ever-larger share of a shrinking pie just to keep up.

"My dog's blacker than yours" in twelve European languages

Part of me

Part of me wants to stress over flight connections and the like. For the amount of emotional energy I expend in this way it's the only viable explanation.

Air travel: a procession of small humiliations.

Heathrow Express: your air travel experience starts here

Getting good at the new thing

Kevin Kelly recently posted a great essay entitled What You Don't Have To Do.  He sets out hierarchy of ascending levels of 'working smart': -

1. Doing what is required
2. Doing more than is required
3. Trying as many roles as you can in order to discover what you are smart at
4. Making sure you are spending your time on jobs that are effective or that need to be done at all
5. Do only jobs (that really need to be done) that you are good at doing
6. Doing that work that no one else could do

This is a profoundly elegant understanding of what success looks like.  It's how a good careers have always unfolded: apprentice then journeyman then master.

When I think about those around me in unhappy careers (which is not the same as being in an unhappy workplace) oftentimes there's a disconnect between where someone believes he sits on this ladder and what the employer believes.  You won't be paid a premium to do something only you can do until you prove you can do the things anyone else can do*.   A clear sign that you've gotten this wrong is when your veiled threats about quitting are met with bemusement.  Or relief.  You will only extract a greater cost from your employer if you're operating at Level 6.  The leading lady can shut down production by staying in her trailer.  The extra playing Nervous Inmate #3 cannot.

Having a relatively new career in stand-up comedy to compare with longer ones in pharma consultancy and improv provides me with a natural experiment in this.  As a consultant I'd like to think I operate at Level 5 and occasionally 6; I deliver good work and many clients reckon that only I can do that work.  As a stand-up comic I strive to stay at Level 2 where success on any given night is measured in doing more than simply surviving the show.  But perhaps the bitterest pill to swallow is that even though I'm a 20-year improv veteran (i.e. I started this before consultancy) I'm no more than a solid Level 4.  Whilst I can be relied on to deliver a solid performance, I've never been indispensable to the long-term success of a show.

My proof that this is more than an unusually piquant blend of my standard brew of self-pity and smugness is that whereas I often get unsolicited approaches to do consulting work that is interesting, specialised (and therefore lucrative) in the comedy world I'm just another name on a list.  Without a constant effort keeping my name in front of promoters I don't get gigs.

Nevertheless though hard work and luck I have one aspect of my working life, consulting, where I'm seen as a bit special.   Regardless of what the motivational bloggers say, not everyone has or will ever have that.  The brutal fact is that even sweat and ego-free dedication do not guarantee progression in an adult life.  This is why a late-life career change scares us so: what if we run out of time to actually get good at the new thing?

* Freelancers: replace the phrase 'the employer' with 'the market'.

Best thing last week

Monday morning.  Manila.  I'd asked the group for any opening thoughts.  A Filipino sales manager stands up and recites an obscure passage of my book verbatim.

I'm big in Mindinao.  No one can take that away from me.

Not an elephant. Not in the room

I finished up in Seoul on Friday afternoon and will be back in London for dinner with friends on Saturday night. The programme, a 'how to coach' session for a sales team's first line managers (FLM's), went better than I dared expect.  The translation on slides and workbook wasn't risible and whilst interpreters unavoidably lessen my impact this one, despite an unedifying pre-game battle of wills, wasn't too bad.

The long-term efficacy of the session won't be determined by the guys in the room but by the one who wasn't.  The newly appointed National Sales Manager (NSM) didn't grace us with his presence for more than a few minutes over the two days.  The subliminal damage to the supposedly high priority given to my project is potentially fatal.  As engaged as the actual attendees were, some corner of their collective brain registered the absence as commentary of sorts.  When I ran into him in the corridor (the session was staged in the client's offices) he didn't look especially busy and his English was certainly on par with anyone's in the room.  He declined the offer to close the session on Friday afternoon even before the General Manager, a far more assured character, jumped on the opportunity.

I'd say that he's either totally contemptuous of my project or shit-scared of his FLM's.  Manipulating your new boss such that he's wary of you is a necessary skill in many organisations and low-ranking sales managers often hunt as a pack in this regard.  Korean sales teams have an uber-masculine sensibility and the NSM missed the perfect opportunity to assert the necessary alpha male status by either: -

1. Taking total ownership of my ideas, which is of course fine by me; or, 
2. Openly challenging the foreign 'expert' over how little he understood the local market. This would have been less fine but nothing I'm not paid to deal with

Instead he stayed in his office down the hall whilst his subordinates challenged me anyway.  He stayed away, seemingly unnoticed, as his boss loped in and claimed the last word.  To be fair, his is a lovely office.  He should enjoy it while he can.

Full of bile and venom

Last night's sleeplessness, Manila traffic and the ambient chaos of Niño Aquino International Airport had me arrive at the departure gate chock full of bile and venom.

Of the myriad vestigial rituals clinging to 'luxury' travel the procession of interruptions that are supposedly the hallmark of good service pisses me off the most.  As pointless as airline safety demonstrations may be I accept that a legal logic is in play.  But tell me why I must hear from multiple crew members on other topics?  Why is the captain as well as the purser compelled to make an announcement before take-off then again 'once we're airborne'? Why interrupt the inflight entertainment (wishfully claimed as a USP) to tell me that you're going to interrupt me again later?

Am I alone in measuring good service in terms of the least number of staff intrusions? Who was the last person actually pleased by hotel turndown service?  I don't understand the logic: if I'm out I most likely won't notice the alteration in bedlinen when I return.  If I'm in then whatever I'm doing is interrupted whilst I answer the door and say, "No thanks".  Not all porn channels have a pause function you know.

The threat of a hovering proprietor is the main reason I shun the English Bed & Breakfast.  Once you price in the energy expended gushing over the farm fresh eggs and the wasted ten minutes being shown the frankly troubling collection of objets d'art on the mantlepiece that country house hotel down the road looks like a bargain.

But whereas creepy B&B's can be avoided air travel is inevitable.  Scripted platitudes droned out in multiple languages (I've been on Korean Air lately) and of course the seatbelt sign is illuminated before it starts so we can't even bury our ears in headphones.  Any airline that starts from the assumption that I don't need to know by name the captain, first officer, whoever else is assisting them on the flight deck, the person heading up 'my' cabin service team and the rest of the crew will get my business.

Wow. One solitary solid week of travel and I'm whining like Tyler Brûlée.

Pricing jetlag into the fee

1am in Ortigas City, the affluent precinct of Manila where I've been staying since I arrived in the Philippines exactly 72 hours ago.  I'm wide awake and out of Stilnox (aka Ambien).  I've only eaten lightly, used the hotel gym and self-medicating with red wine will only make the waking hours harder.  I'm 50% through the project.  Tomorrow I fly to Seoul to repeat what I've just delivered only this time via a (client-sourced) interpreter who claims, but only when chased, that she still hasn't received my slide presentation.  Interpreters are often hard to deal with and this augers poorly for the rest of the week.

I tell myself to suck it up.  Self-employment means that in the end every problem belongs only to you.  The only sane response is to price interpreter angst and the inevitability of jetlag into the fee.

Being present. In Manila

It's 5am in Manila.

This is the time I usually wake up but jetlag has had me in its throes for about 90 minutes already.  I've doing the calculations: two hours until breakfast with the client, three and a half hours until we start the session and at least 12 hours until we wrap up Day One of this two-dayer.

'Twas always going to be thus.  I got to the Philippines at midnight Saturday and spent all Sunday sleeping and searching out the least sweetened food the hotel had to offer.   I went to the gym and I reviewed the programme.  I gave the project my complete attention.  I was the epitome of professionalism.

This is what business travel is: an exercise in discipline.  And the rules are as obvious as they are simple: don't go crazy at the starch'n'sugar-laden buffet breakfast, say no to (at least some of) the free alcohol, decline those Sunday night drinks with ex-pat pals, don't kid yourself that you can get away with being a tourist for a day.  And never complain about the horrors of the flight or its attendant jetlag.  The job can only really begin once  you've made a connection with your audience.  Why would go out of your way to remind them that you live on the other side of the world?

I have been brought here because I am the best person to communicate certain specific ideas to their people.  If they believe they could achieve the same thing with a local or even Asia-based speaker then I wouldn't be here.  So my goal is simple: minimise all the factors competing for my attention and concentrate all available energy on being present.

Harder than it sounds.  I'll let you know how I get on.

Don't pack drunk

Summer is done and I'm traveling again: Madrid, Edinburgh, Manila, Seoul and Zurich to begin with. No complaints: if I'm not on planes I'm not getting paid.

Travel means packing and packing always makes me feel stupid. Specifically, packing is an exercise in imagining my future self and experience has taught me that that guy is an idiot. Indeed most travel planning could be described as 'negating your inner idiot'.

These oh-so-unimpressive alternative selves exist inside each of us. Stress brings them out. As does fatigue, distraction brought on by overwork and alcohol.

I've learnt to mitigate these minor demons with low-level paranoia. Printing out and filing the limo pick-up instructions for Ninoy Aquino airport now means one less thing for the idiot-me to forget to do later.

In pre-travel mode I become a parent to myself. Lists are made and checked off. I run semi-conscious wargaming exercises like, 'If the programme was pulled forward to tomorrow would you be ready?' I update the weather app on my iPhone to flag destination cities (Manila, 30C, thunderstorms, if you're wondering).

And don't pack drunk. Turning up in Toronto in January equipped for summertime Sydney taught me that. Not unless you want fur-hatted Canadians pointing you out in the street.

Authoritative rapid Spanish

Some jobs lurch so far outside my control that any pressure to perform simply evaporates.

The other week I was booked to deliver an afternoon workshop for a Spanish sales team that was running two hours behind schedule after two hours.  I was due to follow the presentation of marketing plans for the rest of the year, which was essentially the centrepiece of the entire meeting.  As the morning dragged on it was obvious to everyone in the room that short of wrapping up around midnight something in the agenda would have to give.  And as often happens in such situations the client was forced to choose between delivering vital information (the marketing plans) and recouping a large sunk cost (my workshop).  The big boss chose me and instructed the marketing guys to 'just talk faster'.

Regular readers of this blog will know that I speak no language other than English.  Even under normal circumstances I find Spanish a daunting language to listen to; staccato and without the tonal range of French or Italian.  To my ears the demand that a Spanish speaker speed up was like putting a machine gun on fast forward.

For me at least, the effect was extremely compelling.  In the words of Elisa, Selma Hayek's wonderfully sexy nurse character on 30 Rock: -

I find that authoritative rapid Spanish subdues white people

Big bites in Big Pharma

As this next, even scarier phase of the Global Financial Crisis takes hold it appears that Big Pharma is much of its implicit losing political patronage.

The Spanish government is looking to cut its drug bill by €1.3B by demanding price reductions in both the off-patent and soon-to-be-off-patent medications.  By hitting branded drugs as well as generics (i.e. those already off-patent) a signal is being sent by the Minister for Health & Social Policy: -

The pharmaceutical bill rises to nearly €15 million annually and the government becomes the largest customer in this sector...  We demanded a lot to the industry and we believe enough is enough

In the UK the National Institute for Clinical Excellence (NICE) has decided that none of three leading treatments for metastatic colorectal cancer are good value at their current pricing.  This will effect Roche (Avastin), Amgen (Vectibix) and Merck Serono (Erbitux).  The NICE statement said that it was: -

Disappointed not to be able to recommend cetuximab (Erbitux), bevacizumab (Avastin) and panitunmumab (Vectibix) for this stage, but we have to be confident that the benefits justify the cost of the drugs

This is especially bad news for Roche as Avastin, the world's largest selling cancer medication, is under ongoing FDA scrutiny as a treatment for metastatic breast cancer in the US.

Boehringer-Lilly have been scared off launching diabetes medication in Germany due to legal-administrative changes that place a greater onus of the company to ensure that a new drug is value for money: -

Reorganisation of the Pharmaceutical Market (AMNOG), (which) was established in January this year to regulate the pricing of newly approved drugs within their first year.  This means that Germany's NICE equivalent IQWiG and a new Federal Joint Committee (G-BA) now assess a drug's cost-effectiveness against a suitable comparator and if the drug fails to demonstrate its cost-effectiveness, then its manufacturer may be liable to refund the government's Statutory Health Fund, which originally paid for the treatment.

It looks as if the German government called Boehringer-Lilly's bluff.

And all of this in the (somewhat) solvent north of Europe.  As I've mentioned previously, further south the picture is different.  In Greece the government is issuing zero-coupon bonds to pay its pharma bills.  Roche said that the conversion of their debt to a bond amounted to a loss of 26% when the bonds was converted to cash.

Of course as Greece racks up more debt a 26% 'haircut' might look like good value.  Assuming that Greek bonds of any value are still deemed to be assets in the months ahead.

Buying time, expecting attention

In the early 90's I once worked on a project to establish a sales/marketing culture for a mid-tier pharma company establishing it's own Australian operation for the first time. Their products were important, if a little mundane and somewhat limited in scope. The company had identified that as the size of the business meant that there was almost no scope for career advancement it was going to struggle to recruit effective salespeople.

Their solution was to staff the sales force with experienced women looking to reenter the industry after having children. Prima facie it was a good fit. The company needed solid experienced performers but who weren't interested in promotion and the women wanted to rejoin the workforce but on more sympathetic, less careerist terms. With the right HR attitude to flexible working hours it looked like a 'win-win'.

For a while it worked well enough. The new team was highly energised and quickly established a healthy, credible presence in the marketplace. Sure, the job-sharing and ongoing maternity leave coverage issues required additional Head Office and sales manager admin but no more than had been anticipated.

About nine months later, after the initial euphoria of launch had died down, the mood changed abruptly. Both management and the individual salespeople were suddenly, totally disenchanted. The company expected the women to still be grateful for the opportunity to rejoin the workforce on such sympathetic terms and that gratitude to manifest itself as greater attention to detail. The women couldn't see what the problem was: they were turning up and doing the job (sick kids who needed early collection from child care notwithstanding) weren't they?

The women were selling time only whereas the company thought that their (complete) attention came as part of the package. Within a year the complexion of the team had shifted back to the usual blend of unambitious old stagers, thrusting careerists and a few women with young children but decent family support to allay the early-pick-up-from-child-care-issue.

No pregnant person can give an employer his or her complete attention. Ditto for anyone with a new baby. It doesn't matter of that baby is real or metaphoric (i.e. a nascent IOS app, a comedy career or a that business you're starting up on the side) and it's no less true if both you and your employer buy into the fiction that selling only your time will be sufficient.

Something you love more than your job is always going to take attention away from that job. Because in part that's what love is.

Blue chin syndrome

Thinking further about this need to earn an audience's attention reminded of a phenomenon that Grainne Maguire, a stand-up comedian friend of mine, calls 'blue chin syndrome': -

The gig isn't going well when out in the darkness you see all these blue chins; audience member's faces uplit by their mobile phones as they text their friends

This is bad enough when the device in question is a Nokia.  If they bring out the iPads it's probably time to vacate the stage.

Earning attention

At his non-rambling best Merlin Mann is one of my favourite contemporary online writer-thinkers.  Lately he's been energetically promoting the idea that what counts in life is not so much where we spend our time or money but rather where we focus our attention.

Every professional performer has endured the experience of a paying audience getting bored and talking through your act: -

Even after they've given you their time and money you still have to earn your audience's attention

The signals that you've yet to earn that attention are pretty blatant if you know what you're looking for.  My first corporate theatre gig, which was also my first paid work after I quit the marketing department of Coca-Cola, was a morning of team building for some long since subsumed Sydney freight company.  The maiden outing of Alternative Corporate Training Services (aka 'ACTS')* was in mid-December 1991 and the job had been a long time coming.  Our show used improv techniques to teach teamwork to corporate types but we'd really just been hired to make the group laugh for an hour whilst they set up for Christmas lunch in the room next door.  I have three distinct memories of that afternoon: -

1. There was no air conditioning so it was stifling.  It was Sydney in December and our hour was the only thing between the group and a fridge full of icy beer
2. We took the 'stage' (read: walked to the space at the front) to the Emerson, Lake & Palmer version of Fanfare to the Common Man.  The idea was the entrance would be epic but as the venue had no sound desk we'd brought along an old boom-box, which I had to clunk on then hold above my head from the back of the room
3. As we started the MD, who hadn't signed off on our appearance, sat at the foremost table took out a massive mobile phone and ostentatiously placed it in front of him

The signal was as clear as day: you have my attention but only for as long as no one (anyone) from the outside world wants it.  The amateurishness of our entrance, our visible lack of self-belief and even our dumb company name meant we hadn't earned the right to ask him to switch off his phone.  Everyone in the room knew it and our gig went downhill from there.

There's a moment with every audience when you have to 'get them'.  If that point in time passes without you earning the room's attention you will struggle thereafter.  The same rule applies with absolutely every kind of audience; a target market of prescribing doctors, an electorate or an online community.

That day in 1991 we stumbled through the hour by dropping the team building message and playing for laughs, which is all they wanted anyway.  They paid us in cash and we went directly to the Chinese restaurant up the road and spent the entire fee on our own boozy Christmas lunch.  Late that afternoon our pager beeped (we shared the one between us) and a booking agent offered us a gig at a January kick-off event.  At that second, boom-boxless, gig we earned the attention of the room and ACTS-CORPRO-Instant Theatre-Dramatic Change went on from there.



* Because we were a theatre group.  Geddit?  No?  Anyone? This was the first of our dumb company names.  After that we went for CORPRO Productions ('Corporate Impro') before getting to Instant Theatre then Dramatic Change

Desperate times, desperate measures

The question of whether American drug reps are salespeople or robots is back to the Supreme Court.  If the suit is successful then the pharmaceutical industry will owe its (former) employees many millions of dollars in unpaid overtime.

This is a natural consequence of Big Pharma viciously downsizing its sales teams at the end of the blockbuster era.  The companies have no choice but to shed all these jobs but as the entire industry is contracting their laid-off employees can pursue this overtime claim with impunity.  There aren't enough new jobs emerging in the industry so there's no reward for not being labelled a troublemaker who went after this additional cash.  If you're not going to get another gig anyway you might as well try for whatever you can get?

Structural change.  Boy, I don't know...*

* With apologies to Aaron Sorkin

The fourth bite

I'm in California catching up with friends.  Last night my wife and I dined with them at a busy family restaurant (pizzas, burgers).  The atmosphere was buzzy and the wait staff were as friendly as the portions were huge.  So to my banal observation of the week:-

American restaurant food loses its flavour at the third mouthful

The plate looks great when set down in front of you and that first bite is amazing.  As are the next two.  You find yourself thinking that America is the greatest country on earth.  Then almost immediately your palate jades.  You start reaching for the salt and pepper and hot sauce.  You start picking out the protein and vegetables and leaving the starch.  You start breathing heavily.  Your sense of struggle is heightened as you realise that you're not yet halfway through the obscene pile of food on your plate.  You find yourself thinking that it's no wonder that America is the fattest country on earth.

But look around you.  No one else at the table is even attempting to finish their serving.  Only a gluttonous fool eats much past that fourth mouthful.  No big deal.  The busboy appears and removes the Americans' unfinished meals.  Only we two Australians, raised in a different eating culture, doggedly persist.  We plough on, well past the point of discomfort and mocked by the knowledge that what we're now doing is actually unhealthy.  Eventually we concede defeat and the accusing plates are taken away.

"Now, I hope you folks have all left enough room for desert?"

And it begins again.

Disappointed Bridge

Disappointed Bridge was the dumbest company name I ever came up with. The business in question was going to be the TV production arm of a theatre company we'd been running successfully in Sydney for a number of years. As part of this move the three founders invited Bryan to join us as a partner. He was a friend with a strong background in television but I suspect he really only came on board because of our cool offices.

And they were so, so cool; a former dance studio with a massive sprung wooden floor in a converted pier with panoramic views of the Sydney Harbour Bridge. The space was far too big for our meagre needs when we weren't actually rehearsing but when a friend offered us the chance to sublet, the wow factor was such that we couldn't turn it down.

Immediately after Bryan joined us we settled into the artfully spaced sofas and started brainstorming ideas for the new venture as a matter of urgency. Nothing so workaday as ideas for an actual television show mind; we needed a cool name for the business itself. And only a name as cool as our offices would suffice.

We ran an unsurprising gamut of obliquely clever and archly fey suggestions, including the obvious but taken 'Pier Productions', when I hit upon it, "Disappointed Bridge Productions!"

This was met with a predictable silence. I'd been reading James Joyce's Ulysses (which tells you everything you need to know about who I was at the time).

"There's a great joke in Ulysses: 'What's the definition of a pier? A disappointed bridge.'"

Genius, I thought; a company name that was apposite, witty and just a little off the mainstream. Just like the TV we planned to make.  Bryan, who knew me less well than the others but TV far better was withering in his sarcasm, "Yeah, because it's going to sound great when we're waiting in the lobby of Channel Nine and the receptionist calls up and says, 'The guys from Disappointing Bridge' are here to see you".

Bryan now makes lots of TV. I do not.

Waiting for a life-changing event

"A lot of farmers," said my brother-in-law, "won't move from their unsustainable farming practices until they have some sort of 'life-changing' event."

We were on a tour of the farm where I grew up in the 70's and 80's that he now runs with my sister and he was lamenting the unenlightened habits of many Australian farmers.  As I've mentioned before, he's an enthusiastic (evangelical) proponent of holistic farming.

I suppose the 'life-changing event' he imagines is some not-quite-fatal event like a heart attack or having the bank seriously question whether the farm's debt should be allowed to roll over.   But as any doctor will tell you non-fatal heart attacks are rarely life-changing.  We're humans and we hold our habits, good and bad, far closer than we'd like to admit.

It is useless to try and reason a man out of something he wasn't reasoned into.

Jonathan Swift

My brother-in-law has it wrong.  The 'life-changing event' he's seeking isn't for the farmer but the farm.  The best hope for changing practices on a given bit of dirt comes with change of ownership through inheritance or sale; and new ideas are far more likely to be trialled under totally new ownership of the asset.

The land we drove over was first used for grazing cattle in 1819 by a man named William Lee who helped build the very earliest road over the Blue Mountains to the west of Sydney.  Lee was granted title to something like 60,000 acres in 1832.  Over the years that holding was broken up into smaller properties although the Lee family are still prominent in the district.  My father bought our farm (4300 acres) from the Lees in the early 1960's.  The land has been owned by only two families in the almost 200 years since white settlement reached that part of Australia. Not a lot of scope for 'life-changing events' in that timeline.

It's a great modern example of the most persistent economic unit in history: the family owned and operated farm, reports of whose demise have been greatly exaggerated.  That persistence is borne of an old fashioned mindset; farmers who create a life that serves an asset that will outlive them.  This is at odds with the way that almost everyone in the rich world lives; we build a life that serves the personal needs of our families and ourselves.  We build unremarkable bourgeois lives instead of creating then stewarding some good thing that will outlive us.

As much as we freelancers believe that we're different from the wage slaves we used to be, in this respect we're exactly the same.  Seriously expecting your son to one day take over your web design business is as weird as assuming that he'll ascend to your regional sales manager role.

We have to admit that we're not building assets, just lives, and the best we can hope for is that most bourgeois of aspirations: leaving enough cash in the kitty for our kids to have their choice of futures.

Do unto others...

Over the years and around the world I've worked with many of the major pharmaceutical companies but for whatever reason I haven't often crossed paths with Pfizer.  As such my impressions of the world's largest pharma company has usually been that of their competitors.

For over twenty years Pfizer has been the most ruthlessly single-minded marketing outfit in the industry.  By flooding doctors' offices with legions of undertrained reps, often as many as eight per territory for a single product, it sold good drugs (Lipitor, Viagra) in a bad way.  This successful focus on 'share of voice' triggered an arms race wherein every company selling a product in Primary Care had to proliferate sales reps or else be elbowed out of the doctor's mind.  This deluge of drug reps selling poorly differentiated products by parroting two or three key messages with scant regard for a prescriber's clinical needs has destroyed the industry's claim to be a partner in the fight against disease.  Most doctors now see the industry not as a partner but as an enemy and Pfizer's 'share of voice' strategy is a major cause of this shift.

As I said, I've not done much work for Pfizer but I've often been brought in to help prepare a defensive response to an upcoming Pfizer launch into a given market.  Even in specialty care fields like oncology there's a perception that Pfizer will enter the fray with a massive sales/marketing investment dispatched with a discipline that feels like violence.  All of those barroom laments at sales conferences about the underhanded things done by 'the other guy' are usually about the Pfizer rep.

This ruthlessness goes way beyond the hurly-burly of a couple of reps scrambling after a prescription in a suburban clinic somewhere in America.  Pfizer has effectively declared war on the government of New Zealand by demanding that Pharmac, the highly effective regulatory body charged with controlling the country's drug costs, be neutered in the name of an impending Free Trade Agreement.  Admittedly Pfizer isn't acting alone here and so far the NZ government has stood its ground but this story has a way to run yet.

You could argue that Pfizer really isn't any different from any of the other players (i.e. my clients); just a little more focused on the bottom line and a little more eager to adopt practices that will hurt the entire industry in the long term.

I disagree.  Lipitor, the largest selling drug of all time, is now off patent and in pursuit of this bottom line Pfizer is devouring the very people who drove that success.  I can just about stomach the job cuts because we could all see those coming; although this is cold comfort to the 16,300 employees losing their jobs in the coming weeks.  What I wasn't aware of was Pfizer's longer-term move to cap (American) retiree health benefits at $11,700 p.a. despite the cost of the policy being over $22,000 and rising.  The ex-employee pays the rest.  According to the Placebo Effect blog this will save the company about $534 million a year.  When Pfizer's sucked you dry it really does just discard the husk and move on.

The only justifiable stance the pharma industry has ever been able to take was set out by George Merck in 1950: -

We try never to forget that medicine is for the people.  It is not for the profits.  The profits follow, and if we have remembered that, they have never failed to appear.  The better we have remembered it, the larger they have been. 

In pursuit of profits Pfizer has thrown so much under the bus; the one-to-one relationship with the doctor, the collegiate nature of the industry, its world class research centres in Kent and Michigan and its own employees, past and present.  Its decline from industry dominance is not to be lamented.

Negativity bias

I am a social creature.  I enjoy the company of others and have always made an effort to maintain friendships despite living on the far side of the planet from the people I knew growing up.

Technology makes this much easier to achieve than in times past.  Facebook means we can keep up with the smaller details of others' lives and Skype affords us cost-free face-to-face interactions whenever both parties are at the computer, which is most if the time.  Still, there's no substitute for being in a room with a friend so that's how I spent much of my time in Sydney last week.

As I've mentioned earlier when an ex-pat comes home after an extended absence a damned-if-you-do-damned-if-you-don't mechanism kicks in.  As with any scenario where resources are finite (i.e. my time in this case) but demand is practically infinite, a zero-sum game develops.  Time spent catching up with one person is unavailable for any other purpose be it work, sleep, exercise or seeing someone else.  This fact is as obvious as it is brutal but its very obviousness creates a different, more subtle problem.

Most of my friends and family in Australia lead successful (read: boring) lives so these one-on-one catch-ups often turn out to be boring conversations that go something like this: -

Me: So how's everything with you?
Old Friend: Great.
Me: Family?
OF: Great.
Me: Job?
OF: Great.
Me: Parents.  How're your parents doing?
OF: Good...

Quickly pressure starts to mount under the conversation.  We both feel it.  After all I've made time for this one person to the exclusion of all others and we can't seem to lift the discussion out of bourgeois banality.  My old friend feels the need to somehow sing for her supper so she drags something out of left field: -

OF: Did you hear about my sister-in-law?
Me: No.  I don't think I know her.
OF: Oh, I'm sure you would've met her at something.  Anyway, her father has been diagnosed with Parkinson's.
Me: That's dreadful.  It must be very hard on everyone.
OF: Well, they live in Melbourne so we don't really see them that much but it has been hard on my brother.
Me: I think I might remember meeting him at your wedding...

We've moved on from personal banality to surveying the horizons of our person existence for second- or even third-hand suffering to make sure that our time together isn't wasted and by the end of the catch-up we're both a little exhausted.  An entire week of this can leave a guy not only wrung-out but thoroughly depressed as a negativity bias kicks in.  I have to keep reminding myself that I'm not getting a true snapshot of anyone's life.

We want our friends to be there to support us through the bad times so maybe there's a tendency to road-test the disaster scenarios that lie in each of our futures just to see how it feels.  Of course when the truly bad stuff has been and gone we joke about it.  The easiest, funniest conversations to have are the ones where there's true sadness at the heart of the story: -

OF: Did you hear what happened when my Dad got arrested?
Me: No!  I never even heard he'd been in trouble!
OF: It's hilarious really.  Anyway we get this strange call from my stepmother late at night...

All of this effort and analysis is a poor substitution for propinquity but it's all we ex-pats have to offer.

A temporary lobotomy

Whilst in Sydney I endured the most banal of travel mishaps: I left my iPhone in the back of a cab.  We need not dwell on the details except to say that it was late in the evening and that wine had been taken.

My less than sympathetic mother joked that the loss was the equivalent of a lobotomy.  She was 100% correct in that I've outsourced much of my memory and lower-level mental functioning to a shiny piece of Apple.  To people of my parents' age there is still something shameful about an unnatural over-reliance on machines to assist with menial tasks such as addition, subtraction and the recall of phone numbers.  There are two responses to this: -

1. These are menial tasks.  Why expend any more effort on them than necessary?
2. Reliance on an iPhone for memory is no more unnatural than relying on a kitchen for digestion

In his wonderfully thought-provoking book What Technology Wants, Kevin Kelly describes technology as the entirely inevitable next stage of evolution.  A kitchen can be thought of as an external stomach that allows mankind to extract nutrients from a much wider range of foodstuffs.  Our species' ability to survive on cooked foods that can kill us if eaten raw is the reason why we dominate the planet.

Opting out of any technology, be it cooking or iPhone apps, is willfully contrarian and silly.  Still, doubtless there once lived some paleolithic version of me whose mother joked that his preference for cooked meat was proof that he'd gone soft.

London. Dawn. An uneasy peace prevails

Got back to London yesterday after three weeks away. Mostly I was catching up with family in Australia in Far North Queensland and western New South Wales but I also managed the best part of a week seeing friends in Sydney and Wellington (NZ). With all the bad behaviour in England this week I found it harder and harder to 'sell' the UK as a sensible place to live when Oz is an option.

I like Great Britain and I love London but the ambient anger we've seen this week isn't going to dissipate until the city / country regains some sense of shared opportunity. I'm still trying to work out where I want to grow old but I'm not sure I'd stay in the UK if I were still young.

Something bigger than a career

A few years ago in the context of showbiz careers I mused as follows: -

Isn't a successful career just one where you do what you love until you don't have to do it any more?

As I get ready to leave the farm I how this thought might apply to owner-operator agriculture.  Farmers' bodies wear out quicker than most and yet as in Australia 50% will die within five years of retirement, quitting doesn't seem to be much of an option.  If you stay you wear out.  If you leave you die anyway.

'Secession planning' is a growing industry in the bush as smart farmers look to 'step back' and hand the business over to the next generation whilst still retaining some small role for themselves instead of selling the business outright before heading to the coast to die.  Done properly this is a way to extend the enterprise past 40-50 years but done badly it turns into a defensive exercise in personal survival that mortgages the prospects of the next generation.

The critical issue is in the word 'career'.  Your career terminates when you do.  Whereas a successful business is a bigger thing that can (should) outlast you.  Headcount: 1 enterprises are careers that die with us; they can no more be handed on to the next generation than an actor can bequeath her role in a sitcom to her daughter.

The difference is in the asset mix.  Farms must be 'asset-heavy' to flourish whereas any career based on personal talent can function 'asset-light'.  Successful consultants, actors, writers and the like take the fruits of their labours and buy real estate whereas ambitious farmers buy more land, stock and equipment.

This is probably obvious to anyone except a farmer's son who chose to use his brains to make his way in the world rather than stay at home and build a life based on his brains, physical effort and the farm where he grew up.

The wages of frustration

I am still in rural NSW at the farm where I grew up.  The weekend was a reunion of sorts for my three sisters, their manifold children and me.  It's taken me a while to adjust to sleeping in the deafening silence of the Australian bush after inner London but that absence of noise is one of the things that I am here to rediscover.

On Saturday my brother-in-law gave me the tour of his cattle-raising business.  He's made a number of quite radical changes to the farm since my father has stepped back.  He and my sister are enthusiastic adherents to a more holistic approach to agriculture that is quite close to hard-core environmentalism in terms of protecting  pastures and (especially) soil quality*.  To this layman's eyes it seems as if they're on the right track but they'll only know for sure after a few hard years of poor rainfall and depressed cattle prices.

It's easy to look good in the good times.

And this is something that I'm not sure that my brother-in-law, a smart, hard-working man, quite gets yet.  An understanding of the meaning of prosperity is hard to come by.  If you take the long view of a business in any established industry (and none are more established than food production) then a trendline will emerge; a sense of what a good operator can reasonably achieve with his particular assets can be established.  I say 'established' because it takes time for these trendlines to solidify; no one knows what the DNA sequencing industry will look like yet.

Many companies and most Headcount: 1 / freelancer types misinterpret prosperity.  If you treat the good things (it rained, my client got a big promotion, I got the part in the hot new movie) as luck or even as 'just rewards for all my hard work' then that prosperity is mispriced: -

The good years must compensate you for the emotional damage wrought by the bad ones

None of us gets to relive those bad years but with more money in our pockets.  We don't get that time back.  Our health and the wellbeing of our relationships with family will inevitably have been damaged by both the frustration of not having succeeded yet and the quiet terror of not knowing if you're actually going to succeed at all.  When you hear that someone's eventual success 'feels hollow' it means that the bad years were 'not worth it' (or mispriced).

Hopefully my brother-in-law has it right.  Like many smart farmers of his generation he is adamant about carving out time for his other passions: his family and campdrafting, a very difficult, peculiarly Australian rodeo event.  But the proof will be in whether or not he manages to keep up these other aspects of his life when beef prices tank and the rain refuses to fall.

The current good season will have to pay for some future time of heartbreak and frustration whether he knows it or not.

* This is not to say that my father didn't have a keen appreciation of the relationship between his agricultural practices and his land.  He did.  However, to an outsider it does seem that the thinking has moved even in the last ten years.  Even though he doesn't use that language, my father was a custodian of his land, which is more than you can say for most farmers in most parts of the world.

RIP Drew Leavy, improvisor

I woke up this morning at my family home in country Australia to the news that Drew Leavy, improvisor, had died in London.  He had been battling brain cancer for over eighteen months.

I first met Drew after a Grand Theft Impro show.  GTI have long been the best improv troupe in London and Drew, alongside Phil Whelans, Dylan Emery and later Cariad Lloyd, deliver consistently high quality, innovative shows in an otherwise hit and miss field.  As he was from Canada we bonded in that familiar 'colonials-in-Britain' way.  The last time I saw Drew was about a year ago, also at a GTI show, when I was privileged to perform along side him in what I think was his penultimate show.  He was as anarchic, generous, funny and erudite that night as ever.

As with any great improviser, when you made eye contact with Drew across the stage what you saw in there was a sort of 'deliberate unknowingness'; neither he nor you knew what was about to happen, only that it was going to be fun.

Fixing pharma

Matthew Herper writes at Forbes about health care.  Last week he wrote a piece entitled Big Pharma: What Went Wrong?  Much of the article is a direct quote from Peter deVilbiss an ex-employee of Merck, who makes the obvious and off-stated point about pharma R&D: -

It takes a lot of profits from the few approved drugs that make it to market to pay for all the basic research and failed development candidates that lie beneath the surface and out of view of most people

Herper and many others are calling for two key reforms to 'save' Big Pharma: open source sharing of trial results and an end to direct-to-consumer (DTC) advertising.  I have no problem with either suggestion as either or both would improve the bottom line via a reduction in expenses and, in the case of DTC, improve the industry's American reputation.

As a consultant that works mainly outside the US (although regularly in Canada) and usually in more rarefied therapy areas like renal disease and oncology it strikes me that a lament on the evils of DTC is an analysis that is looking at the obvious rather than the important.  DTC is as much a symptom of the Blockbuster era as a cause.  I doubt that medical advances will ever again be as simple or as widely beneficial as the advent of the statins, COX-2 inhibitors and erectile dysfunction agents.  You won't see much DTC advertising of monoclonal antibodies because they're targeted therapies and the ROI on that sort of ad spend won't be there.

This is not to say that commercial medicine is about to get all classy: get ready for a massive increase and unedifying in TV ads for genetic screening: -

Did you know that you could be one of the millions of Americans who have cancer and don't even know it?  Call this number now...

Form versus function

I am in Australia visiting family and friends for the first time in fifteen months.

I've lived in the UK for over six years now and the trips home get harder not easier.  Life moves on and because there are always new nieces and nephews to meet as well as old friends to catch up with, time becomes absurdly, depressingly precious.  Anyone who's lived away from their home for any length of time can testify to the horrible push-me-pull-you feeling that overwhelms the visitor the minute he gets off the plane.

I have about three weeks on the ground in Australia and my time is divided between family and friends on a 2:1 ratio; with my parents in beautiful Far North Queensland (I'm writing this from Mission Beach), with my sisters and their families on the farm where we grew up in country New South Wales and then with seemingly innumerable old mates in Sydney.

It's seeing the mates that creates the stress.  As time is so short at every turn I'm confronted with a simple choice: -

Do I opt for the form of the relaxed rhythms and banter of the old friendship but by so doing risk not getting a real sense of my friend's life or do I sacrifice some of the familiarity that made us friends in the first place on the functional altar of information expediently exchanged?

One feels too superficial yet the other can be brutally businesslike.  Damned if I do, damned if I don't.

Yet like many of the problems in my life, there are far worse ones to have than how to get on when seeing old friends.  I'm reminded of my favourite Christopher Hitchens quotation: -

"A melancholy lesson of advancing years is the realisation that you can't make old friends." 

A segment of one

The old cliche has it that the world can be divided into two types of people: those that divide the world into two types of people and those that do not.  Typically marketers fall into the former category and salespeople into the latter.  We pay marketers to make sense of the big wide world whereas salesmanship rewards an intense focus on the individual customer.

Much of the time I find that the segmentation strategies operate in much the same way as horoscopes: a point of post hoc analysis more interesting than useful from a sales perspective.

Segmentation strategies, predicated on the assumption that a market can be divided into discrete, identifiable, predictable (and thus exploitable) blocs, are like catnip to marketers.  There's nothing a product manager wants to cultivate more than an aura of prescience, omniscience if that can be managed.  There are plenty of strategic research consultancies who will happily take your money whilst promising you that aura.

Things are different in pharma.  Because the major comms channel available to marketers in most markets is the sales team, broad-brush segmentation models often clash with the salesperson's worldview wherein each prescribing doctor is unique.  Imposing a segmentation strategy on a sales team often adds an unneeded element of complexity into the mix and I'm often brought in to assist translating the marketing speak into sales action.  My question for marketers is this: -

A segmentation model implies that different customers will respond to different messages.  How many conversations do you want the sale rep to carry around in her head?

At the moment I'm involved in several such segmentation projects of varying degrees of sophistication.  The most unfortunate of these went live with the sales team recently.  A ham-fisted marketing presentation managed to be patronising of the sales team, which was in attendance, and contemptuous of the doctors, who were not.  It's generally a bad idea to portray a segment of your customer base as "just wanting a quiet life and more interested in his golf game than his patients".  It's an even worse idea to illustrate your point with cartoon imagery usually associated with Covent Garden street artists.

The sales team in question took it with a grain of salt, which is what experienced sales teams do when confronted with overwrought marketing efforts.  If each customer represents a segment of one then the return on effort for fashioning a plan for an individual is far higher than that for memorising 4-5 separate conversations that will apparently 'push the buttons' of the different types before deciding into which segment each customer belongs.

The unspoken challenge in all of this is that even if the strategy is correct and the market can be broken into four or five segments the salesperson still has to dumb down her knowledge of the customer so that he or she conforms to a certain segment.  If you can close your eyes and visualise an individual doctor then a cliched overview is going to be of partial value to you at best.

The stories we tell

For the last five years I've served on the board of trustees for a West London charity. We offer adult education in the form of Numeracy & Literacy and Information Communication Technology (ICT, aka 'computer skills') to unemployed and otherwise excluded people in North Kensington. The charity has been in operation for 28 years and the chief function of the board is to support our inspirational (and formidable) CEO.

As with all charities everywhere, attracting adequate funding is a constant battle. Our geography counts against us we are located in one of the most deprived wards in London (Golbourne) but that ward is in the richest borough in Britain (Kensington & Chelsea). This incongruence means that we attract less funding than similar organisations in the east of the city even though our students, many of whom are refugees and asylum seekers from places like Ethiopia, Somalia, the Sudan and Iraq, are equally deserving.

Lately I've been making a renewed effort to get friends and acquaintances to help us out financially; my strange, schizophrenic social circle includes quite a number of City Types who, at first glance, would be ideal benefactors to an organisation that is doing good work in their own back yard.

Not so much.

This is not to say that my friends aren't generous but rather that as you'd expect your typical City Type finds himself constantly targeted by a bewildering selection of charities representing good causes ranging from small theatres to the Guide Dogs to the local school to disabled kids to the alma mater. With wealth comes the right to pick and choose where you bestow your munificence.

In marketing terms this amounts to: -

Whose story moves me the most?

What I've learned is that even people with even moderately right wing views are not moved by the origin tales of foreigners. An entreaty that highlights a benighted past can result in a shrug of the shoulders or even something uglier. I've learned to save the stories of famine and refugee camps and even the obscene oppression of women for my lefty mates.

The narrative that motivates the right wingers is not where the beneficiary is from but where she's going. They are no less generous but words like 'motivation', 'integration' and 'aspiration' resonate where 'deserving', 'justified' and even 'humanity' fail.

As with any sales pitch it's all about the story; I've learned to distinguish what has already happened from what is yet to come.

Cold-calling a falling man

In these straitened times every client of mine is under pressure all the time.  The cultures of every pharma company pulse with implicit threat: -

Do more with less.  Do it sooner.  Do it right the first time or else...

Some days all of this makes self-employment feel a little better.  It feels as though I have more control over my destiny.  Arrant nonsense, of course, as there's nothing like a job scare to encourage a sales team to attempt a little DIY training.

This pressure on expenses is doubly felt by the pharmaceutical industry; not only is the sector going through the same GFC as everyone else but it faces a systemic threat in the number of hugely popular products that are coming off patent.  A branded medication can expect to lose as much as 80% of its sales within six months of patent expiry and by some calculations the big research companies (aka 'my clients') will lose a further $100 billion in sales to generic manufacturers in the next three years.

This is old news and the industry is responding.  Pfizer is closing research facilities in the UK and invest in sales teams in China.  Novartis has been positioning itself in the generics game with Sandoz since 2002.  Roche completed a takeover of Genentech in 2009 to try and dominate the biologics market.  This year Sanofi-Aventis has bought Genzyme and Takeda has bought Nycomed.  The M&A industry has plenty of reasons to love pharma.

This can make life a little tricky for a Headcount: 1 consultant trying a few cold calls but with one eye on his summer holidays.  Here's an ex-client's response to my friendly hi-how's-it-going email: -

Yes i do remember you.  It is probably not the right time to come in -- we have just been taken over by XXXX so things are a little unsettled at the moment.  Sorry can't help at this time

 Not my finest moment as a salesman.

How to dress like a consultant

In the past I've mused about the dangers of overdressing for meetings.  The reverse is also true; the Epicurean Dealmaker usually blogs on the inner workings of Wall Street but this week he's taken aim at a risible WSJ article on women's 'business fashion'.  In the consultancy game, whether you're a man or a woman, this is advice is worth heeding: -

Clients of professional service organizations generally do not want the people who work for them to be flashy, extravagant, or prone to calling attention to themselves.  They want service.  They want reliability.  They want sobriety.  Calling excess attention to yourself in any way that is not directly related to identifying, analyzing, and solving the client's needs is both offputting and counterproductive.

An old truism of the theatre is that you shouldn't ever perform in front of anything more interesting than your act.  In front of the client it's just as important to be more interesting than your clothes.

In life, actually.

White coats in far flung lands

No reader of this site would be unaware of the placebo effect (aka the 'white coat effect') which is usually defined as something like: -

The measurable, observable, or felt improvement in health or behavior not attributable to a medication or invasive treatment that has been administered

Your attitude to placebos is probably driven by your overall attitude to health care.  One side of the argument is that that anything that offers a sick person a respite from the effects of his disease has value.  People holding this view are renaming the phenomenon the placebo response; whatever it is that's going on is broadly on our side.  The opposing view is that what's being peddled is fraud and false hope; we're tricking the patient into believing that something substantial is being done and the fact that the patient's own brain is in on the ruse doesn't excuse anyone.

The placebo effect / response is the bete noir of pharmaceutical research.  If you've sunk upwards of half a billion dollars into developing a drug then 'no better than placebo' is not want you want to hear at the end of Phase III trials.  The brutal logic is that there's no point in subjecting the patient to an expensive treatment that is undoubtedly accompanied by a raft of side-effects when with a little encouragement the patient's own body can achieve the same response on its own.

And apparently we're seeing a strange increase in the placebo effect.  A few years ago Wired Magazine ran a great Steve Silbermen article entitled Placebos Are Getting More Effective.  Drugmakers Are Desperate To Know Why.  It tracks the work done by Dr William Potter, a researcher at Eli Lilly, who observed that new antidepressant and antianxiety medications were actually being overtaken by placebos in as many as nine out of ten trials.  Potter questioned two assumptions that are pivotal to clinical trials: -

1. If a trial is managed correctly, a medication will perform as well or badly anywhere in the world
2. The standard tests used to gauge volunteers' improvement in trials yield consistent results

It turns out that part of the problem stems from (surprise, surprise) the pharma industry's habit of scouring the globe for the cheapest option to undertake any necessary work; more and more clinical trials are using centres in Eastern Europe, Russia, China, India and Africa.  Something that's of great concern to the hand-wringing lefties of this week's Guardian: -

Places such as South Africa – where mostly vulnerable poor with low literacy levels are recruited and the culture is to accept authority without question – are fertile land for ethical misconduct

I accept that ethical misconduct of every kind is more likely in the less developed world (viz. Nestle infant formula) but I reject the knee-jerk implication that such exploitation is inevitable.  The irony is that the problem of the spreading placebo effect may be a result of exploitation in the opposite direction: -

A patient's hope of getting better and expectation of expert care—the primary placebo triggers in the brain—are particularly acute in societies where volunteers are clamoring to gain access to the most basic forms of medicine. "The quality of care that placebo patients get in trials is far superior to the best insurance you get in America," says psychiatrist Arif Khan, principal investigator in hundreds of trials for companies like Pfizer and Bristol-Myers Squibb. "It's basically luxury care."

Wired, ibid

When a Big Pharma company grandly states that its mission is to 'improve the lives of people across the world', I strongly doubt that the promotion of the placebo effect is what it has in mind.

The unreasonable man

Whereas back in UK the 1.7million-person cost containment system known as the NHS continues to frustrate all who encounter it, both within and without.

I've long been of the view that the scarcest resource in the entire network is human energy required of a health care professional who will fight for the good of the patient.  This is not to say that there's malice or even negligence at work but rather an inertia that elevates older and cheaper therapies over newer, more expensive ones.  Doctors are soothingly told to be reasonable, to avoid cruelly raising a patient's expectations with talk of state-of-the-art treatments.  All of which brings to mind the great GBS: -

"The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself.  Therefore all progress depends on the unreasonable man."

George Bernard Shaw

Which is certainly true of the NHS; drug budget blow-outs are avoided due to the reasonableness (read: exhaustion) of the staff.  An entirely unspoken aspect of the British pharma representative's job is to locate that rare unreasonable man.

More thoughts on Greece

Thinking further about the situation in Greece, Simon Kuper wrote an especially poignant piece in the weekend FT that compares the ordeal about to be thrust upon middle class Greeks with that of Argentinians in 2002.

And there was my Argentine friend who lost her mother.  The mother, a nurse, had fallen ill, deteriorated, and then died without ever being diagnosed.  Afterwards, my friend deduced that she had had a brain trauma.  Being a nurse, the mother had apparently diagnosed it herself, decided that treatment would be too expensive, and quietly died.  All these people felt disbelief.  This couldn’t be happening to them.  It turned out that there was no safety net, no benevolent state.

This goes well beyond what the pharma industry can alleviate: if there's no money for basic health care there's certainly no money for biologic agents.

The callous disinterestedness of the NHS

In the last month I've been out ‘on the road’ for three days observing sales representatives selling into the NHS.  As with any sales job the days are long and usually frustrating.  Busy doctors are always cancelling appointments.  The rest of the time gets filled with the strange burden of minor expectations that health care professionals, from the most senior doctor to the student nurse, have of the pharmaceutical industry.  Branded pens and Post-It notes have been banned but the ‘drug rep’ is still the conduit for funding for educational meetings here and abroad and for sandwiches (“We prefer a selection of wraps from M&S”) at least once a week.

What struck me hardest was the visible level of stress being carried by every NHS employee.  It had been a couple of years since I’d been out in the UK system and I was surprised by the universal interest in the price of the drug being sold.  Once upon a time only pharmacists and payers bothered to discuss cost; doctors and nurses didn’t sully their minds with such mundane financial matters.  But last week I watched a junior nurse, who is years away from prescriber status, quiz the rep about the comparative cost of rival treatments.  The nurse didn’t seem to be aggressive or point-scoring nor was he being clever for the sake of it; he just saw it as part of his job to understand the treatment options from a financial as well as a scientific-clinical standpoint.

I can’t think of another government department anywhere in the world where cost-consciousness pervades so thoroughly through the hierarchy as in the NHS.  Of course everywhere there are low-ranking teachers, police and perhaps even soldiers who are aware of their departmental budgets but not so consistently across an entire system.  By some counts the NHS is the second largest employer on the planet and every one of those employees has been trained to count the pennies. 

The taxpayer in me supposes that this is a good thing but I'm also sure that this cost-consciousness contributes significantly to the stress levels I saw in English hospitals.  No one ever went into the caring professions because they enjoyed the budgeting process yet this is now a substantial part of the job.

The reps I shadowed were selling expensive drugs.  This is true by definition: the only cheap drugs are ‘off-patent’ and so with insufficient margins to justify the formidable expense of a sales team.  With the NHS set up the way it is, any conversation with a drug rep is going to end with him asking for something that is difficult financially.  The medicine in question may amount to a revolution in the fight against a given disease but the health care professional is still left with the same old zero-sum game: - 

I cannot treat any patient as well as I would like to treat every patient

This has seeped into the organisation’s DNA.  Last year when the new Coalition government announced its Cancer Drugs Fund (CDF) the idea was for doctors to stop acting as financial comptrollers and get back to practicing medicine.  Yet the initial budget of £50,000,000 for the first twelve months will be underspent by a considerable margin.  This is not because Britain doesn’t have enough cancer sufferers to justify the money but because doctors across the country are genuinely suspicious about the long-term consequences of adopting newer, more advanced treatments in case the funding is later withdrawn

I've sat in on those sales calls.  I've seen doctors agree that there are patients under their care who would benefit from the drug in question.  But when the CDF is mentioned I've watched them narrow their eyes and ask for assurance that they weren't being tricked into changing their practice in an ultimately unsustainable way.  The logic being that it would be better to deny all current patients a better treatment if future patients would be denied it also.

 At the heart of the global financial crisis is the dawning realisation that for the first time in centuries we have to accept that future generations may lead less happy lives than us.  We are faced with the fact that the constant improvement in general wellbeing that the West has enjoyed since the mid-18^th Century is not inexorable.  If you work in the NHS then every day you're learning this unpalatable truth first hand: Britain cannot afford to keep offering every citizen continually improving health care.

By God that’s a stressful way to work.